Psychological Evaluation of Nicholas A Miller
by sequoyagirl
Summary: Nick has to undergo a psychological evaluation after an incident at work.
1. Chapter 1

_This started as a suggestion on one of the forums - I had said I was hesitant about writing fiction as it had been so long since I had done it, but in jest said I could write a "kick-ass psych eval" of Nick. Several folks were really excited and someone (I can't remember who, and I can't seem to find the thread anymore) gave the idea that it was for an anger management eval. In any event, here is my conceptualization of a psych eval for Nick. There is a bit of a twist so I made an addendum as well. I tried to make it as realistic as possible to an actual eval that I would have done (I have actually done court-ordered evals in the past). It's not a typical story but I hope you enjoy it._

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Psychological Evaluation of Nicholas Aaron Miller

**Referral:** Nicholas A. Miller (Nick) was court-ordered and referred to this clinician for the purposes of an anger management evaluation related to an aggressive outburst at his place of employment (Clyde's Bar), where he works as a bartender.

**Description of Initial Incident:** According to police report, Mr. Miller got into an altercation with a male customer who was reportedly engaged in conversation with a female patron at the bar while Mr. Miller was on shift. The incident report indicated that both parties were detained and subsequently ordered to undergo evaluation. Police who responded to the scene noted several conflicting accounts of the altercation from other bar patrons and friends of Mr. Miller and the male customer. Mr. Benjamin Turner and Mr. Patrick "Doin'It" Carson (bar patrons) stated that Mr. Miller has a history of angry outbursts and that he was unjustly interfering with the male customer, who was just trying to "hit that" (presumably, make a sexual advance on the female patron). Mr. Winston Bishop (lifelong friend and roommate to Mr. Miller) stated that Mr. Miller was defending the honor of the female patron in question, who had a history with the male customer and was reportedly upset by the attention. Mr. Robert Malala (a coworker of Mr. Miller – also referred to as "Big Bob") stated that the male customer had come to the bar a few times in the past, and was known to be a nuisance, though had never been in an altercation before. He also reported that Mr. Miller was fairly protective of the female patron in question, and he grudgingly acknowledged that his coworker had somewhat of a short temper. Finally a Mr. Schmidt (roommate and "best bro" of Mr. Miller - as per police report, he refused to give his first name, which was also inexplicably absent from his driver's license) stated that Mr. Miller did have "anger problems" (as per police, he used air quotes when making the statement), but was provoked by the male customer. Further interviews with Mr. Bishop, Mr. Schmidt, and the female patron (Ms. Jessica Day – roommate and former girlfriend of Mr. Miller) are discussed later in this report.

**Behavioral Observations:** Nick Miller is a 31-year-old Caucasian male. He was dressed in a flannel button-down shirt, jeans, and loafers, and was unshaven, with about 2 days worth of stubble. Mr. Miller made a concerted effort to avoid the couch in my office; he initially stated that he refused to lie down as he knew "what happens on shrink's couches." When I informed him that he did not have to lie down, and that he could sit wherever he was comfortable, he sat at a low chair opposite me, leaned forward and stated "let's get weird." He spoke with a noticeable Chicago accent and anxiously rubbed his thumbs on his hands. I went over the informed consent process with him, and discussed the court-ordered nature of the report, as well as the fact that I would need to render an opinion and provide recommendations about his anger/aggressive behavior to the court. He stated that he attended 3 years of law school (though dropped out prior to graduation), and was aware of the procedure. I encouraged him to be forthright throughout the questioning and not conceal or lie about anything that may be relevant; he responded that he is unable to lie as when he does so, he sweats profusely and his "back turns into a slip-n-slide."

**Social History: **Mr. Miller stated that he was born and raised in Chicago, Illinois, and is the oldest child of Walter and Bonnie Miller. He reported that his mother was a homemaker and his father was involved in a variety of dubious business dealings (largely gambling), that kept him away from home for long periods of time. Nick acknowledged that his father's absence often meant that he had to act as the man of the family from a young age, and took responsibility for paying bills, fixing things around the house, and in general looking after his mother and brother, Jaime. During the interview, he often referred to his father as "Walt" rather than "Dad," and seemed very conflicted about his relationship with his father, who he stated had passed away fairly recently. He stated that while his father was very charismatic, he would sometimes run afoul of "shady people;" Nick reported that the family was homeless and living out of a van for a period of time, and stated that at times he would have to fake diabetic seizures (do the "sugar ray") to get his father out of tough spots. He noted he is fairly close with his "ma" and speaks to her on the phone regularly.

In terms of peer relationships during childhood/adolescence, Nick reported a longtime close friend from childhood (Winston Bishop), and a small group of regular friends/acquaintances, but noted that he was not like other kids. When asked what he meant by this, he stated that he was always a "grumpy old man in a kid's body;" he reported marked symptoms of anxiety, particularly harm avoidance, and borderline paranoia. He made some vague statements about government conspiracies but they did not seem legitimately delusional; rather more social mistrust, and possible hyperconcern about criminal activity which may be related to his father's business. He stated he met his best friend (Schmidt) while in college at Syracuse, and though he referred to him as a "total douchebag," it was evident that they were very close.

He noted fairly typical sexual development (first serious girlfriend: Alison Daniels; sexual initiation: age 16) and indicated a pattern of dating and relationships that is often referred to as "serial monogamy." Nick stated that his most serious relationship prior to his most recent one was with a woman named Caroline, whom he met while attending Syracuse University. He reported their relationship lasted around 4-6 years, though they broke up frequently so an accurate timeline was difficult. He also stated they lived together for a time, and attempted to live together a little over a year ago before ending the relationship for good. Nick indicated that Caroline was somewhat manipulative and saw him as her back-up plan. He noted several other semi-serious relationships over the past several years, but nothing as significant as his most recent.

Mr. Miller stated his current social network is primarily composed of his roommates: Winston Bishop, Schmidt (again, no first name given), and Jessica Day, who was also Mr. Miller's girlfriend until recently. He noted that things between them are "fine" and that they are still "friends" but his non-verbal behavior suggested he was not pleased with the turn of events. He initially appeared reluctant to talk about his relationship with Ms. Day, but ultimately admitted that they had broken up because he didn't think he was good enough for her. He spoke highly of Ms. Day, saying she was "wonderful," "crazy in a good way," and "the best thing that ever happened to me" and was clearly saddened that the two were no longer together. He acknowledged that it had been very difficult since their break-up, as he wanted her to find someone who "deserved her" and "could give her everything" but was heart-broken at the thought of her dating someone else.

**Psychological History:** Nick denied any personal history of mental health diagnosis or treatment. He stated he had never attended counseling, though it had been suggested a few times after his various break-ups with Caroline. He indicated that for the past year or so, he has begun to meet with an older Asian gentleman (named Tran) in a local park, who is "very wise" and helps him "calm down" and "figure things out." He also asked about using water massage as therapy.

**Educational/Occupational History: **Nick denied any special education needs or learning disabilities, and reported he was an average to above average student, depending upon how much the subject interested him and how motivated he was. He stated he knew he wanted to go to college, and knew that to get there, he would need a scholarship, so he graduated high school with a 3.8 GPA and was accepted to Syracuse University. Nick noted that his grades slipped a bit in college as it was the first time he had been away from the responsibilities at home, and he enjoyed the freedom. He indicated he had always intended to be a lawyer, though when questioned, he could not really articulate why, other than it was a stable profession with the potential for a good salary. He reported that he did well on his LSATs and was accepted into UCLA Law school, only to drop out after 3 years as he realized he really did not want to be a lawyer. He noted working a variety of jobs as an adolescent to help support his family (pizzeria, paper delivery, mowing lawns, etc.) and stated he began bartending in college as a way to make ends meet. Nick stated he has worked at Clyde's bar as a bartender for 6 years, since leaving law school. He noted no current career aspirations, but was receptive to some vocational/aptitude testing to see what he is best suited for.

**Substance Use History: **Nick acknowledged that he is a fairly heavy drinker, and noted he first tried alcohol at the age of 15. He reported that his roommates have described him as a "borderline alcoholic" and a "drunk," but stated that his use of alcohol has decreased in recent months, corresponding with his relationship with Ms. Day. He noted that alcohol use, in general, is fairly common in his social circle, and spoke fondly of a homemade drinking game centered around American history called "True American." Nick admitted to some use of marijuana and hallucinogens (specifically, shrooms) while in college, but denied any regular use since that time, stating that it was a "phase." He stated he was not drinking on the night of the incident in question (BAC confirmed Mr. Miller was not intoxicated and also confirmed the other gentleman was well above the legal limit).

**Legal History:** Nick stated he had been "arrested" once for trespassing on the grounds of a Mexican resort while vacationing with Ms. Day, but denied any lasting legal consequences as his roommates were able to barter a car for his release. He also reported another incident in Mexico several years earlier where he tried to enter a cockfight (as a person) and was detained briefly, but again, had no lasting consequences. Finally, he noted a series of jaywalking fines from an overzealous traffic officer while on a date with Ms. Day, but no other legal problems.

**Collateral Interviews: **Interviews with Mr. Bishop, Schmidt, and Ms. Day were conducted to get additional information on Mr. Miller. Winston Bishop stated that he has known Nick since childhood, and was aware that he had a great deal of responsibility placed on him at a young age due to "Pop-Pop" (Nick's father) being gone; he also noted that the Millers were "a little special" and needed a lot of guidance from Nick. Mr. Bishop reported that his friend was and is a good guy, but just gets overloaded and has difficulty coping with things. Schmidt reported that Nick is his best friend and one of the best guys he knows, but has issues with self-esteem (his exact words were "a delicate, chubby flower who hates himself.") He noted that he had been against Nick's relationship with Ms. Day in the beginning, but realized later how good they were for each other. He also asked if I could put a recommendation in that Mr. Miller be court-mandated to lose 5-7 pounds. Finally, Ms. Day spoke highly of Nick, saying he was "rough around the edges" but "a very good, sweet man." She expressed regret about the end of her relationship with Nick, and indicated that she wished they were still together as she loved him a lot, but he had trouble believing her. She also noted a lot of guilt about his arrest, stating that the gentleman at the bar was a previous boyfriend (Spencer Hoff), and was not taking the hint that she was no longer interested.

**Test Results: **Results from the Personality Assessment Inventory suggest Mr. Miller experiences moderate levels of anxiety (cognitive, affective, and physiological) indicating ruminative worry, tension, difficulty relaxing, and overt signs of tension. Additionally, moderate cognitive symptoms of depression were noted (feelings of worthlessness, lowered self-esteem) as was irritability. Some hypervigilance was detected, but not to a worrisome degree. Finally, he had moderate elevations on Verbal Aggression, but a low score on Physical Aggression, suggesting that his "bark" is worse than his "bite."

**Overall Impressions/Summary: **

Nick Miller is an affable, if guarded, man in his early 30s. As per his report and the reports of childhood friends, he had a great deal of pressure placed on him from an early age to assume responsibility for the financial, physical, and emotional welfare of his family; this process is referred to as "parentification" and often results in significant anxiety, difficulty with anger or resentment, difficulty trusting others, and/or difficulty developing successful romantic relationships. In Mr. Miller's case, it seems that as a child/adolescent, he was highly guarded and anxious, which manifested as irritable and "grumpy." When he went to college and was not directly responsible for the care of his family, his reaction was to eschew all responsibility and live in a sort of extended stasis, both as a means to avoid the realities of being accountable and due to a deeply held belief that he was unable to achieve or undeserving of having success. His relationships follow a similar pattern – he appears to care deeply for his core group of friends but feels undeserving of their support and love. In the case of Ms. Day, his feelings of inadequacy ultimately resulted in the end of a relationship with someone who genuinely cared about him as he is.

**Recommendations: **

- While I do not think that Mr. Miller represents a physical danger to others, he and others close to him noted difficulties with anger and tension. Mr. Miller's low self-worth, anxiety, and anger are clearly products of his stressful childhood. It is the opinion of this clinician that Mr. Miller would benefit from individual therapy focused on anger/stress management, and cognitive restructuring to enhance his coping skills.

- Mr. Miller is a bright man, though somewhat lacking in self-motivation and sense of purpose. Career counseling would likely be beneficial to help him explore other possible avenues for professional advancement.


	2. Chapter 2

Addendum to report:

I met with Mr. Miller to give him feedback on my evaluation as well as provide the recommendations and gauge his willingness to comply with treatment. He was fairly stoic throughout the discussion, though he continued to rub his thumbs on his hands nervously. He noted that therapy would probably be difficult for him as he does not like to talk about things, but agreed to comply with treatment recommendations, stating that he wanted to be "better." He reported he had gotten back together with Ms. Day, and although he was afraid of "screwing up" he realized he "loved her too much to let her go."


End file.
